The association between pandemic experience and immediate mental health risks, such as depression, is well-documented, yet the long-term effects remain unclear. This study examines the impact of early childhood exposure to the 2003 SARS pandemic on adulthood mental health after 17 years in China, using data from the 2020 China Family Panel Studies (CFPS). The analysis included 6289 participants, aged 3 to 30 years during the SARS outbreak, with an average age of 35.3 years at the time of survey. Adulthood mental health was assessed using Center for Epidemiologic Studies Depression Scale (CESD) and an indicator of clinical depression. The severity of local SARS outbreaks was assessed by cumulative cases per 10,000 population. Results show that each additional case per 10,000 population was linked to a 1.617-fold (95% confidence interval (CI): 1.425–1.836) increase in odds of depression after 17 years for younger children (aged 3–12 years in 2003) relative to older cohorts (aged 13-30). This risk was higher in children from rural areas (adjusted odds ratio (aOR) 3.64; 95% CI 2.92–4.55), with poor physical health (1.98; 1.59–2.48), and from low-income families (2.87; 2.03–4.05). The childhood pandemic experience elevated the probability of developing depression-prone personality traits, which contributes to the enduring impact of childhood pandemic experiences on adulthood mental health. These findings highlight the long-lasting psychological impact of early-childhood pandemic exposure, underscoring the need for targeted interventions to mitigate its effects on the younger generation and emphasizing the importance of monitoring long-term mental health and personality development in children post-pandemics, particularly in light of COVID-19.
This article investigates how environmental adversity affects competitive performance in cognitive-intensive settings. Using a comprehensive dataset of professional eSports tournaments and match-hour variation of fine particulate matters, we find robust evidence that pollution kills competition. Specifically, higher air pollution levels diminish the performance and winning odds of the weaker team in a matchup while boosting that of the stronger team, widening the gap between them. We document two operating channels: (i) pollution leads to heterogeneous performance-reducing effects contingent on a team’s relative strength against their opponent, rather than its absolute competitiveness; and (ii) a weaker team adjusts their strategic decision-making differently in a polluted environment compared to their stronger counterparts. Our findings elucidate the distributional impact of environmental adversity and underscore its influence on strategic decision-making.
This paper assesses the spatial effects of environmental regulations on economic activities. By exploiting the progressive rollout of a national pollution control program in China, which constructed a monitoring network that covered the urban center of every city, we find that polluting firms located in the unmonitored upwind region of the city experienced a substantially larger reduction in output than non-upwind firms after the program. Because the wind can transport upwind pollution emissions to the monitoring network-covered urban center, local governments are incentivized to enforce tighter regulations on upwind firms. Although industrial activities were suppressed, commercial businesses and residential services were promoted in the upwind region, accompanied by a greater supply of corresponding land and increased land prices. Altogether, the monitoring program led to a substantial reduction in population exposure to air pollution and an redistribution of industrial and residential activities within the city. Our findings shed light on the policy-making of future environmental regulation programs.
This paper assesses mental health responses to information on environmental risks. We exploit the progressive implementation of a national program in China that introduces more comprehensive air pollution monitoring and provides real-time air-pollution information to the public. The program leads to a sharp increase in public awareness and attention to air pollution issues and results in a large increase in the sensitivity of individual’s mental health to changes in air quality, especially among those with more exposure to pollution information and those more susceptible to mental illnesses. Information of worsening air quality has a direct effect on mental health as a source of stressors and an indirect behavioral effect through reducing outdoor activities and social integration. Our findings shed light on the design and delivery of environmental information disclosure programs, especially for countries with pressing environmental threats.
China is experiencing a surge in medical malpractice lawsuits. Using administrative hospital panel data, this paper investigates both short- and long-run impacts of medical malpractice lawsuits on patient medical spending and hospital operations. We find that after the occurrence of an additional malpractice lawsuit in a hospital, total medical spending per patient visit increases by 2.8% in the current year and by as much as 8.8% in the long run. This increase is mainly driven by spending on prescription drugs and diagnostic tests. In response, hospitals invest more in medical devices and procure more drugs. We find little evidence of changes in patient outcomes. Our findings show that the surge of medical malpractice lawsuits leads to defensive medicine and fuels the secular growth of medical spending in China.
Unexpected health shocks may bring catastrophic consequences for households. This paper examines the effect of unexpected adverse health shocks on household members' physical and mental health, labor supply, household income and asset, and health behaviors in China by analyzing two nationally representative datasets and adopting a difference-in-differences method augmented with coarsened exact matching. We find that an unexpected health shock results in a discounted out-of-pocket medical expenditure of 16,943 RMB (US$ 2647) over five years for an average household, a reduction of household income per capita of 841 RMB per year (US$ 131, or 6.0% of household annual income per capita), and a loss of net household asset per capita of 13,635 RMB (US$ 2130, or 9.7% of household asset per capita). It raises the probability of an average household applying for public poverty relief allowance by 2.8 percentage points. In addition, we document a strong intra-household
spillover effect of health shocks on mental health and health behaviors. A simple back-of-envelope calculation shows that the health shock induces a private cost of 34,966 RMB (US$ 5463) over 5 years for an average household, and incurs a social financial burden of 6066 RMB (US$ 948) in 5 years per household in medical reimbursement and social welfare transfers. At a national scale, the total social burden of health shocks from cardiovascular and cerebrovascular diseases amounts to 1.1 trillion RMB (US$ 172.1 billion) over 5 years.
